Nurses urged to discuss death with heart patients

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HEALTH workers should have the courage to talk about death with heart failure patients to ensure they are able to die where they prefer, according to a new study by academics in Yorkshire.

Although palliative care for cancer patients in the UK is well established the situation is said to be very different for those suffering from heart failure.

However a new study published today by Hull University and the Hull York Medical School (HMYS) shows when palliative care and heart failure services are integrated it can reduce the number of unwanted hospital deaths.

The “service evaluation” took place in two areas of the region where services are integrated: Bradford and Airedale and also Scarborough.

The study was led by Dr Miriam Johnson, a reader in Palliative Medicine at Hull University of Hull and HYMS and an honorary consultant at St. Catherine’s Hospice in Scarborough. She said: “There’s long been a perception that you can’t talk to heart failure patients about death mainly because it’s seen as difficult to predict when patients are close to end of life.

“However, our work shows that many heart failure patients are able to have honest discussions with their clinicians about their prognosis and appreciate the opportunity it provides for them to make plans and set their affairs in order.” The team found that specialist nurses at the two centres were able to recognise when patients were nearing end of life in most cases and discuss the issues with them.

Over two-thirds of patients put plans in place for end of life and stated where they wished to die – most choosing to be at home – and their preferred place of death was achieved in almost two thirds of cases.

Dr Johnson said: “The specialist nurses hold a pivotal position within the integrated services. They have an ongoing relationship with patients both in hospital settings and in the community and so are best able to judge when patients are nearing end stage disease, are best placed to have those difficult conversations with patients, bring in specialist palliative care clinicians where necessary, and are on hand to help ensure patients’ preferences are taken into account.”